What Do Psychotherapy Experts Actually Do in Their Sessions?

Ever wonder what an “expert” psychotherapist actually does in session? In a recent publication from the Journal of Psychotherapy integration, researchers attempted to answer this question by viewing videos of psychotherapy sessions conducted by experts and coding the behavior of the expert therapists. The research, led by Adelphi University graduate student Nili Solomonov, explored the extent to which the expert therapists adhered to their own therapeutic orientation or integrated techniques from other therapy orientations. The expert tapes came prototypical therapy sessions used in educational videos by Carl Rogers(humanistic/person-centered therapy), Albert Ellis (rational-emotive), Fritz Perls (process-experiential), Aaron Beck (cognitive), Donald Meichenbaum (cognitive-behavior modification), Hans Strup (psychoanalytic), Nancy McWilliams (psychodynamic), Judith Beck (cognitive), and Leslie Greenberg (emotion-focused). The researchers coded the therapy sessions using the MULTI, a coding system that quantifies how much a given therapy session contains techniques from different treatments. What they found was that, although most of the experts used more techniques from their declared orientations, they also drew significantly from techniques of other orientations. The authors also found that when the therapists used techniques of other orientations, they were often techniques of orientations that were similar in being directive vs. exploratory. For example, Nancy Williams used many techniques from psychodynamic therapy but also drew substantially from person-centered psychotherapy, another exploratory therapy orientation. The authors also explored the specific techniques that therapists within the same therapeutic orientation employed. For example, Aaron Beck often identified flaws in reasoning and consequences of beliefs while Judith Beck most often identified consequences of new behaviors, encouraged change, and engaged in search of evidence for or against beliefs. Contrary to what the authors expected, however, there appeared to be no differences among the younger vs. older generation of therapists in the rate at which they made use of techniques from different therapeutic orientations. Expert therapists, it seems, have been borrowing from other psychotherapies for generations now! The authors end with recommendations for future research and training in different psychotherapy modalities.